Fluctuating phenytoin levels in a patient with epidermolysis bullosa dystrophica

Epidermolysis bullosa dystrophica being a genetically determined disorder, and when other factors that could cause fluctuations in the serum phenytoin levels are being eliminated, it is likely that the wide fluctuations of phenytoin in the blood could be a pharmacogenetic variation. The only course of action left in such patients could be to monitor the drug frequently and ensure that the levels are within the therapeutic margin